[Glypressin and emergency sclerotherapy, deferred emergency shunt (Warren, portacaval, mesocaval): new tactics in the treatment of severe hemorrhage by esophagogastric varices in cirrhotic patients].
Transplenic decompression of esophageal varices by distal splenorenal shunt according to Warren (DSRS) aims to a selective detention of the esophago-gastric varices, also assuring an adequate portal perfusion and hypertensive state of the porto-mesenteric district. The DSRS though, should and must not be performed in emergency as a high mortality rate is registered in all cases of emergency porto-systemic derivations. A mortality risk is reported even during endoscopic sclerosis if performed in emergency compared to the elective procedure. The scope of our study was to test the validity of a new approach of the hemorrhagic cirrhotic patient: the end point was to stop the bleeding with Glypressin and deferred sclerotherapy, associating a selective shunt at 40-60 days. Out of 32 patients with esophago-gastric variceal bleeding, 8 were selected also for derivative surgery. Results show Glypressin as the first and best therapeutic approach. The drug in many cases stops bleeding or at least reduces the blood loss allowing an easier endoscopic sclerosis. Further sclerosis and/or surgical therapy may assure variceal eradication.
Huscher
C
C
Divisione di Chirurgia Generale e Centro di Gastroenterologia ed Endoscopia, Ospedale La Memoria Gavardo, Brescia.
Biraghi
M
M
Chiodini
S
S
Recher
A
A
Torri
F
F
Zamboni
F
F
D000328:Adult; D000368:Aged; D004630:Emergencies; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical; D011170:Portasystemic Shunt, Surgical; D015911:Sclerotherapy; D000077585:Terlipressin
D008236:Lypressin; D000077585:Terlipressin
Glipressina e sclerosi mirata in urgenza, intervento di derivazione (Warren, porta-cava, meso-cava) in urgenza differita: nuova tattica per il trattamento delle gravi emorragie da varici esofago-gastriche nel cirrotico.